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Tram Flap Reconstruction

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bjoangtx View Drop Down
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    Posted: Jan 13 2010 at 1:34am
I would appreciate any information anyone has on the tram flap procedure. I posted under radiation/mastectomy earlier. New tothe site. My initial surgery didn't go as planned. I had expected to have immediate reconstruction and instead had an infection and have to look at some other options. Possibly radiation and tram flap although I think if I forgo radiation I can go for expanders and implants. The idea of taking muscle from your back sounds so painful/debilitating who knows. I'm just starting to get a little energy back and it's hard to think of another surgery. Anyway I would appreciate whatever information/experience you could share with me. Still haven't figured out the profile page but I'll mess with it tomorrow before work.
Thanks
 
Joan
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Carol (Tenn) View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Carol (Tenn) Quote  Post ReplyReply Direct Link To This Post Posted: Jan 13 2010 at 4:20am
Joan,
Although I know nothing about reconstuctive surgery, I wanted to answer so that you know you've been heard.
I'm sure someone will be here to answer your question soon.
So sorry to hear about everything getting all messed up and pray you will get the answers you're looking for.
Love and Prayers,
Carol
St 2 Gr 3, A/C/T, DD
Radiation x35
Rec chest wall 07/09
Radiation x28
NED 10/24/11
NED 10/5/12
NED 03/15/13
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Post Options Post Options   Thanks (0) Thanks(0)   Quote cg---cg Quote  Post ReplyReply Direct Link To This Post Posted: Jan 13 2010 at 9:01am
http://www.breastreconstruction.ca/living_tram.htm
 
Dear Joan,
 
I had a left modified mastectomy in May 2007.  I had radiation following because I wanted to ensure there were no rogue cells.  I was an A cup and not a lot of skin covering my chest area.  Doctors will tell you they can do the expanders and implants on radiated skin, but in my experience as a medical transcriptionists doing these reports daily and the subsequent revisions, women ultimately are not happy with the results especially thin women because of capsular contraction, hardening, etc.  I did not have any reconstruction and do not regret it.  But this is a personal decision.  I do know it is easier to 'match' when a person has bilateral mastectomies and reconstructive procedure done on both breasts at the same time.  Some surgeons are very skilled on 'matching' the other, others are not - and that is where looking at the work is a very good idea.
 
If you consider doing the surgery I strongly advise you to go to an expert in the field...not someone that does a couple....and if you can find a plastic surgeon who does breast reconstruction and has a background in art - you will have a result that would fool God!  There are some plastic surgeons who will do absolutely AMAZING results and there will be others that will lack the artistry to make you feel beautiful and not maimed.
 
If I may be bold and suggest you take a deep breath, put on the brakes and not succumb to any pressure.  Decide whether you need or want the radiation and after that point, start looking to see who is in your area.  If you will share your location there may be women on the board who have gone to plastic surgeons who specialize in breast reconstruction. 
 
Remember, this is an important surgery, how many times do we get to recreate a body part to our specifications....and a surgeon's talent so it is very important to look at their portfolios to see the before and after pictures of reconstruction.  You want someone the does this EVERY day, not once in a blue moon.  Ask about the infection rates, ask about the follow-up care. 
 
They are coming out with new and better implants. 
 
Keep asking the questions and when you come to the decision right for you - a peace will come over you.  Your body needs to be healthy and recovered before you entertain a major surgery...and get out a piece of paper and put down the pros and cons of each reconstruction as pertains to YOUR life. 
 
Love,
Connie
 
 
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Post Options Post Options   Thanks (0) Thanks(0)   Quote cg---cg Quote  Post ReplyReply Direct Link To This Post Posted: Jan 13 2010 at 9:13am
http://www.drsaretsky.com/texas_breast_reconstruction_before_after_photos.php
 
Joan, check out this guy - he was voted best plastic surgeon in Dallas.  Look at his website and at least have a second opinion from him. 
 
Love,
Connie
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Post Options Post Options   Thanks (0) Thanks(0)   Quote bjoangtx Quote  Post ReplyReply Direct Link To This Post Posted: Jan 13 2010 at 10:37am
Morning,
 Thanks to everyone for the support. I think I have a signature now but maybe not. I do feel as if I have been pressured and frightened from the work first time I laid fingers on the lump. Just this low level fear that colors everything and has changed me so mu. I wanty to do what s dwolf (hope I got that right) mentioned yesterday and just tell them what I want to do and get it done w/o being so afraid and feeling bullied. I go to the Dr's sometimes and I feel like i'm playing dueling abstracts. He quotes a study and counter with a different one he throws out statticss and I point out how they dont break out TNBC's or prophylactic mastectomies. Rock, paper, scissors, breast! The fear and the anger have changed who I am more that the chemo and the surgery. I'm okay with bald but the constant not in my stomach, the yearning for unconsciousness at time, the way I snap at people I'm not angry at (believe me snap is a euphamism for what I have done and I'm trying to do better.)
 
I have lost 2 people in my life who I expect would have left at some other time anyway. Hurtful but good to know.I am so afraid I'll never enjoy sex again, or want to see myself naked w/o flinching. I hate the hospitals because unconscious I have no control, I hate when people who haven't done this tell me what I'm doing wrong or suggest I do it better. I am tired of having expectations and being dissappointed when it doesn't happen the was I was told it would.. Yikes early to get wrapped in this much self pity.
 
Anyway if you've had the tram how long were you down for? How much pain? Any complication? Do you like the results? What's you're back like? Anybody out there do yoga? I'm gonna lose it if I don't find something to do besides breast cancer.
 
Everyone is great here. I love reading the archives and realizing how much has changed procedure wise but we remain similar. The emotions, the support, the fear and the grief, the anger and the gratitude. I don't want to do this but I can watch you and learn.
 
Joan
St 2 Gr 3 2/5 nodes dx 8/9 age 56 Neoadj ACT @ x 6 @3wks bi mst. 12/09 Infect expander 12/31 remvd, replcd 1/27. 28 rads 4/10 Brkn rib 5/10 PET   6/10 NED Recon 9/17 & 12/10 Ki67 85% basal
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rena View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote rena Quote  Post ReplyReply Direct Link To This Post Posted: Jan 13 2010 at 11:53am
Hi Joan. I had the tram flap in 1993 and a major repair of it in 2007. I can tell you more about my experience, but I noticed that you mentioned the back muscle. The surgery that uses the back muscle is the latissimus dorsi flap, which is completely different. The tram flap uses abdominal tissue.  If it is the tram you're considering, I'll go into more detail about my experience. I agree totally with the idea that finding the best surgeon is key. I didn't the first time I had the tram and ended up with a real mess. In 2007, I found a San Francisco plastic surgeon who studied at Stanford under the doctor who pioneered the tram flap. She is both an artist and a master technician. For the first time in more than 20 years, I actually look like a woman again. So, before you choose any kind of reconstruction, be sure to ask a lot of questions: How many of the procedure has the surgeon performed? Before and after photos? Can you speak to one or more former patients who had the procedure? (obviously, the doctor won't refer you to anyone who was dissatisfied, but you'll get an idea of how open he/she is). Just remember that it's your right to interview and evaluate the doctor--you're a consumer of his/her services. Good luck! Rena 
Diagnosed 9/86. 1 cm tumor, 22 positive lymph nodes. CMFVP chemo, weekly for one year. 7 weeks radiation. BRCA2-positive. Multiple attempts at reconstruction (three's a charm)
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Bonnie Quote  Post ReplyReply Direct Link To This Post Posted: Jan 13 2010 at 1:03pm
Rena:  Would you be able to share the name of the female plastic surgeon in San Francisco that you found?  My daughter, Ashley, is almost to the point of treatment where we can start looking for a plastic surgeon and discussing her reconstruction options.  I want her to have the best.  If anyone else knows of a good plastic surgeon trained in the flap procedures, please feel free to share with me.  Ashley will be having 6 weeks of radiation and we've been told that there are few plastic surgeons who will attempt expanders on radiated skin.
Bonnie
Bonnie - Daughter Ashley dx TN 8/09 @ 22; St3, BRCA1/2-; AC&Ixempra done 2/10; mets to lung 3/10; G/C 3/10; PARP 6/10; sternum mets 9/10; NK012 failed; mets to liver, spine, kidney; Avastin/Xeloda
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rena View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote rena Quote  Post ReplyReply Direct Link To This Post Posted: Jan 13 2010 at 1:31pm
Hi Bonnie. The group I went to in San Francisco is called Women's Plastic Surgery. http://womensplasticsurgery.com/  There are two female doctors: Dr. Loren Eskenazi was mine--she is the older one (in her 40s) and tends to do a lot of the repair work on botched reconstructions. The other, Karen Horton, also has an excellent reputation. But if your daughter is in Florida, she should take a look at this group in New Orleans: http://www.breastcenter.com/  Dr. Frank Della Croce's name comes up often on the Komen website. He's supposed to be excellent. Best wishes to your daughter. Rena
Diagnosed 9/86. 1 cm tumor, 22 positive lymph nodes. CMFVP chemo, weekly for one year. 7 weeks radiation. BRCA2-positive. Multiple attempts at reconstruction (three's a charm)
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Bonnie Quote  Post ReplyReply Direct Link To This Post Posted: Jan 13 2010 at 1:39pm
Rena:  Thanks so much for your quick response.  I'll check out both groups you mentioned.
Bonnie
Bonnie - Daughter Ashley dx TN 8/09 @ 22; St3, BRCA1/2-; AC&Ixempra done 2/10; mets to lung 3/10; G/C 3/10; PARP 6/10; sternum mets 9/10; NK012 failed; mets to liver, spine, kidney; Avastin/Xeloda
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Post Options Post Options   Thanks (0) Thanks(0)   Quote bjoangtx Quote  Post ReplyReply Direct Link To This Post Posted: Jan 13 2010 at 6:18pm
Rena your right. It is the lat flap. I don't have enough skin from my stomach and i had my spleen removed after a care accident in 81 so the won't mess w/my abdomen. Everybody I've talked to w/o exception is recommending rediation, That limitsmy choices. I'll send more later but thanks for the responsethissite means alot to me.
St 2 Gr 3 2/5 nodes dx 8/9 age 56 Neoadj ACT @ x 6 @3wks bi mst. 12/09 Infect expander 12/31 remvd, replcd 1/27. 28 rads 4/10 Brkn rib 5/10 PET   6/10 NED Recon 9/17 & 12/10 Ki67 85% basal
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Laura41 Quote  Post ReplyReply Direct Link To This Post Posted: Jan 13 2010 at 6:37pm
Hello everyone,
 
Do you know if actually immediate reconstruction can be performed after double mastectomy, when you have to have radiation after?
 
I am having Chemo prior to surgery (they didn't know about BRCA1+ at time of Chemo start and the purpose was to shrink the tumors down) and finishing end January and my breast lead surgeon who is a Professor, but not a plastic surgeon, however he did reconstruction too, says the double mastectomy and immediate reconstruction can be done and is to be scheduled towards end February. I am indeed confused, what's your recommendations?
 
Laura
 
dx: 10/2009 @41, IDC TNBC Stage II, Grade 3, 3.1 cm lupms in right breast, one lymph node, BRCA1+, having Chemo prior to surgery AC x4 plus Taxol x4 dense dose bi-weekly
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rena View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote rena Quote  Post ReplyReply Direct Link To This Post Posted: Jan 13 2010 at 7:31pm
Joan, a number of women who post of the Susan G. Komen website (komen.org) have had the lat flap. If you want more input on that procedure, you can post your questions on the Sound Off and Surgery boards. Be patient--it sometimes takes a few days for people to respond. I also have a good friend who had the lat flap, and I'd be glad to put you in touch with her if you'd like. Just send me a private message with your email address. Rena
Diagnosed 9/86. 1 cm tumor, 22 positive lymph nodes. CMFVP chemo, weekly for one year. 7 weeks radiation. BRCA2-positive. Multiple attempts at reconstruction (three's a charm)
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